Compassion or Criminalization

Drugs and the plants they are derived from, have been around for centuries.  From locals in South America who chewed on coca leaves (cocaine), to soldiers who sucked on the sap of the poppy (opium) before heading into battle.  For almost 150 years in the United States, you were free to ingest any substance you wished. And many did.  Not only in America, but around the world.

What changed over time, was the method of delivery to the central nervous system.  The first evolution on the path to addiction came as people went from eating a plant to smoking it.  Historians say at the peak, 1/3rd of the population of China was seriously addicted to smoking opium.  Crippling their country to such a degree, they went to war with the British to try and free themselves from the stranglehold of their supplier.

The next evolution was the invention of the hypodermic needle, coupled with a more potent opiate, synthesized as morphine.  After the American Civil War, due to high morphine use for treating injuries, typically by amputation, hundreds of thousands of soldiers returned from battle as addicts.  Eventually on main street, drugs like cocaine became a common ingredient in everything from Coca Cola to cough syrup.  Widely used “patent medicines”, meaning they didn’t disclose the ingredients, contained up to 50% morphine by volume.  And perhaps most infamously, Sears and Roebuck sold doses of heroin, hypodermic needles, and a convenient carrying case for a $1.50 through their mail order catalog.

At a time of great ignorance, addiction flourished.  But the unfortunate reality is, decades later, in spite of all our knowledge, and in spite of all our efforts, drug addiction continues to this day.  Laws prohibiting drugs, and therefore criminalizing those who consume them, have not eliminated demand, but merely created a black market to supply it.  This has taken an enormous toll on our society and should be reexamined.  We need to ask ourselves, should we continue paying such a high price for the “War on Drugs”, or is there a more effective and just social policy that reflects the real world we all live in?

To begin to answer this, I believe we should first look to history, with the rise and fall of alcohol prohibition.  In an attempt to deal with alcohol abuse, the Temperance Movement lobbied for the passage of the nation’s first vice law, the Volstead Act and corresponding 18th Amendment to our Constitution, prohibiting the production and distribution of alcoholic beverages.  The consequences were staggering.  Almost immediately, legitimate businesses who supplied the market were replaced by gangsters like Al Capone who battled in the streets for control.  As their power and financial resources grew, so did their ability to corrupt local officials.  Meanwhile, demand for alcohol actually increased in places, as the underground speakeasy scene became in vogue.  Eventually, enough people realized the “cure” did more harm than the disease, and alcohol prohibition was repealed with the passage of the 21st Amendment.  It should be clear that this experiment of using the law as a way to treat alcohol abuse not only failed, but actually lead to new problems that were detrimental to society.  The same can be said today with drug prohibition.

“Prohibition goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation, and makes a crime out of things that are not crimes.” — Abraham Lincoln

While Harrison was the first attempt at using the law to deal with drug abuse, the real legislation came in 1970 with the Controlled Substances Act that prescribed categories for classifying drugs as being controlled for medical use or banned altogether.  In the 40 years that have followed, the United States has spent hundreds of billions of dollars fighting a “War on Drugs”.  Billions given to agencies like the DEA and even other countries to try and stop suppliers from feeding the black market.  Billions spent on local law enforcement arresting our citizens.  Billions spent prosecuting people through the criminal justice system.  And billions more spent locking drug “offenders” up in already overcrowded prisons.  Could this money be better used elsewhere?  Are there more serious crimes our police force and courts could be focusing on?

There is no question drug abuse is a serious problem.  It ruins lives and rips apart families.  But there has to be a more effective way to address it.

From a demand side, it seems to make more sense to treat drug addiction medically, by funding treatment facilities, rather than “correctional facilities” that don’t correct anything at all.  Along with better education.  In fact, the only law that has ever lead to a significant drop in drug consumption, was actually not a criminal law.  Rather, it was the Pure Food and Drug Act of 1906 that required disclosing ingredients, such as in those patent medicines.

From a supply side, I believe the best thing that we could do from a policy standpoint is to repeal drug prohibition.  Think about it in pure economic terms.  A black market by definition is fueled by artificial scarcity.  The actual powder substances they distribute are nearly worthless.  They aren’t rare, there is nothing inherently valuable about them, just their difficulty to obtain.  And thus, because they are illegal, the black market can inflate the price exponentially, creating enormous profit margins.

The dealers are in it purely for the profit margin.  The easy money.  If you legalize drugs, you remove the artificial scarcity of the commodity, thereby destroying the profit margin, and thus remove the incentive for that black market to exist.  Consider the effect the repeal of alcohol prohibition has had.  When is the last time you heard about an alcohol kingpin trying to smuggle in six-packs on speedboats?  Or dealers selling vodka shots on street corners?  It doesn’t happen.  It’s not financially lucrative for them, since alcohol is legal.  The same would happen with drugs.

Most people associate crime with drugs.  But dealers aren’t fighting over drugs.  They are fighting to protect their profits.  Remove their profits, remove the associated crime.  The one exception is an addict who will commit a crime in an effort to purchase a drug.  That won’t go away by repealing drug prohibition.  But it’s also not going away with drug prohibition.  Which is why we should focus our efforts there on fixing the root cause.

Many parents feel their children would be at greater risk if drugs weren’t illegal.  However, most students will tell you it’s easy for them to gain access to drugs if they really want them, in spite of the fact that they’re illegal.  Even more so than alcohol and tobacco.  Because the black market doesn’t check your ID.  They don’t care, as long as you have money.  Illegal does not mean unavailable, it just means available from the black market.

Now, I am not naive to the risks of drug legalization.  History has shown the dangers of drug addiction to society.  There are no perfect solutions.  But surely history has also shown us from the rise and fall of alcohol prohibition, that the cost of a “cure”, should not be greater than the cost of the disease.  Particularly when the law is not curing anything at all.  Instead of fighting a losing war on suppliers and consumers, we should accept the reality of demand, and treat it directly.  We should not ask cities like Harlem, or countries like Mexico, to pay the price in blood on their streets, for the broken policy in our laws.

We should not imprison our citizens for substances they choose to ingest into their own bodies.  We must relieve the burden on an already overwhelmed prison system.  Our prisons have become places where we banish people with any problem society doesn’t want to deal with.  From drugs to mental handicaps.  We need to deal with them.  We need to embrace these people, as fellow human beings.  They need our help, not our dismissal.

We should allow our courts and law enforcement to focus on more critical crimes.  I am astonished when I see task forces, helicopters and all, scouring countrysides for marijuana plants to destroy.  When did we decide police officers should become gardeners pulling up weeds?  The hemp species of cannabis actually has a wide variety of uses, including paper, fabrics, and bio-fuel.  And the marijuana species of cannabis has shown medicinal benefits for those fighting illness.  Who are we to deny the sick among us the help they need?

There are still challenges with legalization.  While I can easily imagine marijuana cigarettes sold next to tobacco cigarettes in corner stores, harder drugs have to be controlled.  They should be available, perhaps even for pennies to further decimate the black market, but limited to facilities that also offer treatment, isolated from easy reach, but still open for access, without fear of being hauled off to jail.

One success story is Insite in Vancouver in the only Supervised Injection facility.  They have seen a significant increase in addicts entering onsite rehab.  And many who would have overdosed and died in the streets, have been resuscitated by nurses standing by when they overdose inside the supervised facility.  Society has also seen a benefit by a decrease in new AIDS cases, which are costly to treat.

For those addicts who will continue to choose these drugs, as a society we should choose a more sensible, effective social policy then what we have today.  But most of all, we should respond with compassion.  Not criminalization.

For every Californian, we will be given an opportunity to do just that in November.  I hope you will consider supporting the common sense proposition to legalize marijuana in the upcoming midterm elections.


Further reading on reforming drug policy by the Drug Policy Alliance can be found at http://www.drugpolicy.org.  As well as a Wall Street Journal op-ed by Ethan Nadelmann.

For a more in-depth look on the history of drugs, I recommend these History Channel docs “Hooked: Illegal Drugs, and How They Got That Way”.  Episodes available on YouTube: 1) Opium 2) Cocaine 3) Marijuana and Amphetamines.

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The Real Cost of Health Care Reform

The Real Cost of Health Care

Like many Americans, I’ve followed the debate on health care reform over the past year.   With every plea for its passage, came another moving story of a fellow citizen’s suffering.  At every turn, with every speech, the case for reform was made.  I listened, learned, and became convinced of its necessity.  Now that H.R. 3590 has been signed into law, it’s important to ask how the actual legislation will impact our lives.

One of the reforms was, “You should never go broke from getting sick.”  A noble sentiment to be sure.  Born out of countless uninsured Americans struck by catastrophe.  Only later to be sent the bill.  Oftentimes, many bills.  Piled up on their kitchen table.  And as I watched each shell-shocked person grapple with the magnitude of suddenly owing hundreds of thousands of dollars, holding the balances up to the camera, along with their contempt, I was left to wonder, what impact will health reform have for them?

According to the legislation, insurance companies will be obligated to offer coverage to every citizen.  They can’t drop anyone for simply getting sick.  And there will no longer be lifetime benefit caps that are generally exceeded when serious illness or accidents strike.  So far so good.  But, you may be wondering.  Those bills for the hundreds of thousands of dollars.  Where will they go now?  Or more precisely, to whom?

Not surprisingly, to everyone else.  In spite of generous promises, health care in America is still a business.  And we all know, there is no free lunch.  The question is, how will the market respond?  Will the individual mandate add enough healthy people into your risk pool to mitigate the surge in benefit outlays?  And to what extent can 3rd party insurance exchanges really drive price competition when the cost of the underlying services are rapidly rising?

This last question is the fundamental disconnect.  There is currently no connection between purchaser and price.  If you or your loved one has a brain tumor, you aren’t going to shop around to see who can perform an MRI the cheapest.  If you’re in a car crash, you aren’t in a position to call around and find out which vascular surgeon will save your life the cheapest.  In fact, the opposite is true.  Because we pay a 3rd party an insurance premium, and since it’s not our money we’re spending, we feel entitled to the best, regardless of cost.  The best doctors, the best technology.  And therein lies the rub.

We have the best doctors, the best technology.  However, this disconnect of market forces I believe to be the primary cause in the unsustainable escalation in provider prices.   While this legislation has attempted to apply pressure on insurance companies, it has done little to control the actual underlying costs at the provider level.  And while it is hopeful that moving many uninsured out of expensive emergency care will help, I have a feeling they’ll still find a reason to bill $1,200 for a toothbrush.

This lack of real change is due to a classic political problem.  It’s easy to hand out new benefits, and demonize the system.  But it’s politically untenable to make substantial cuts.  To ask specialists to make less.  Or hospitals to operate on less.  Or big pharma to profit less.  Which is why every other developed country has wisely adopted a nationalized system.  We have to ask ourselves as a country, are we willing to sacrifice some quality to gain long-term sustainability?  Are we willing to consider structuring the market so it incentivizes cures over treatments, or general practice over specialty fields?  Can we get by with a $100,000 MRI machine instead of a $1 million dollar MRI machine?  I think we have to.  Or at least have an honest conversation.

  • I believe if we mandate set reimbursement prices, like Japan and others do, manufacturers will find a way to supply providers with tools, that may not have all the bells and whistles, but will get the job done.
  • If we limit private insurance to secondary supplemental markets, we can cut the profit and overhead out of critical care.
  • And if we choose a government run single-payer system, and make it no-charge and available to all Americans, the risk pool opens up from your company, to the entire country.

Why should an employer even be obligated to provide health insurance?  They don’t provide car insurance.  Due to rising costs, this American “benefit” has led to stagnation in wages.  And should be decoupled.

And while many people can go their entire life without being in a car accident, statistically speaking every single person will die.  And most will face some medical issue that requires treatment in their lifetime.  So if injury, death, and disease are inevitable to the human experience, why do we think an insurance model designed around accident-based risk even makes sense?

Still, I am proud to have voted for our president.  However, when I look at the overall reform the administration selected, I am disappointed.  I wish we would have taken the approach that Taiwan chose.  They gathered a panel of experts to study all of the major health care models around the world.  They selected the pieces that worked, and addressed what didn’t.

After all is said and done, with $1 trillion dollars in new deficit spending, I’m glad the uninsured can now find coverage.  But I’m afraid the real cost of health care reform was this.  With a once in a generation opportunity for transformative change, instead of fixing the fundamental problem in America.  We merely subsidized it.

And unless we’re willing to have a common sense discussion on who will need to sacrifice for the greater good of society in the interest of sustainability, the health care we all want, may not be around when we need it most.

Perhaps one day, our children will get it right.

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